Masui. The Japanese journal of anesthesiology
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Case 1 was a healthy 28 year old woman. Spinal anesthesia was performed for Cesarean section. After the delivery, prostaglandin F2 alpha (PGF2 alpha) 1000 micrograms was administered intramyometrically. ⋯ Lidocaine 40 mg and nicardipine hydrochloride 0.4 mg were administered. Blood pressure decreased to 120/80 mmHg and ECG showed sinus tachycardia. These cases demonstrate the systemic reaction of intramyometrically administered PGF2 alpha.
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Case Reports
[Cardiac arrests probably induced by hypermagnesemia during anesthesia for caesarean section].
A 24-year-old pregnant woman was scheduled for Caesarean section during the 31st week of pregnancy. The patient had been treated with MgSO4 for premature labor and toxemia. During anesthesia, cardiac arrest occurred twice. ⋯ The second one occurred immediately after administration of methyl-ergometrine malate and seemed to be due to combined effects of hypermagnesemia and methyl-ergometrine malate. The patient and three babies did not develop any complication. In giving anesthesia for patients with hypermagnesemia, anesthetists should take account of interactions between magnesium, anesthetics and other drugs.
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A healthy 34 year old, male (70.2 kg, 168 cm) had lower leg fracture during rugby football and was scheduled for open reduction and fixation. Spinal anesthesia was planned by using Sprotte 24 gauge needle. In the operating theater, patient was positioned for spinal tap on his right side up. ⋯ To prevent these hazards, introducer for the Sprotte needle should be placed in epidural space before the Sprotte needle insertion. Also a Sprotte needle should be placed in subarachinoid space deep enough to prevent failed spinal anesthesia. The tip of the Sprotte needle is weak enough to bend and may present a new patient hazards.
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In 108 spinal anesthetic cases, 2.36 ml of each of five 0.5% tetracaine solutions, either with distilled water (DW), normal saline (NS) or different concentrations of dextrose (2.5%-2.5 G, 5%-5 G, 10%-10 G) was injected intrathecally at the L2/3 or L3/4 interspace. The specific gravity and osmotic pressure of these solutions and cerebrospinal fluid were measured. The cephalad spread of analgesia was greater with higher concentration of dextrose (5 G-Th7.4, 10 G-Th6.0), compared with DW, NS and 2.5 G (Th9.5-9.8). ⋯ The hemodynamic changes after intrathecal injection were small with 2.5 G, DW and NS. Arterial hypotension requiring treatment occurred with 5 G and 10 G. The baricity of spinal anesthetic solution had an important effect on characteristics of the blockade.
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Comparative Study
[Effects of inverse ratio ventilation and positive end-expiratory pressure on gas exchanges in dogs with oleic acid induced pulmonary edema].
The purpose of this study was to determine the effect of inverse ratio ventilation (IRV) on gas exchanges and circulatory systems in 56 mongrel dogs with oleic acid induced pulmonary edema. The dogs were divided into 9 groups and were ventilated with 9 kinds of ventilatory modes such as I:E ratio of 1:2 (control), 2:1 (2:1 IRV), 3:1 (3:1 IRV), 1:2 with 5 cmH2O PEEP (1:2 PEEP 5), 2:1 with 5 cmH2O PEEP (2:1 PEEP 5), 3:1 with 5 cmH2O PEEP (3:1 PEEP 5), 1:2 with 10 cmH2O PEEP (1:2 PEEP 10), 2:1 with 10 cmH2O PEEP (2:1 PEEP 10) and 3:1 with 10 cmH2O PEEP (3:1 PEEP 10), using a Servo ventilator 900C. IRV could not improve arterial oxygenation in dogs with oleic acid induced pulmonary edema, but PEEP could significantly improve arterial oxygenation depending on PEEP level. ⋯ There was no significant alteration in hemodynamics after ventilatory modes were changed to IRV. Although oxygen delivery was the best in the 3:1 IRV group, there was no statistical significance between the 3:1 IRV group and others. It was concluded that IRV did not improve arterial oxygenation but showed a favorable effect for CO2 elimination, in dogs with oleic acid induced pulmonary edema.